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Alabama Pathways PDR Enrollment Application
Child Care Center
At this time, only Enrollment Applications for individuals whose center is eligible to participate in Alabama Quality STARS will be processed and placed into the Alabama Pathways Professional Development Registry (PDR). If you have questions or need assistance with completing this application, contact us via e-mail at help@alabamapathways.org or by phone at (251)473-1060.
Please complete all requested fields. Fields marked with an asterisk (*) are required. It will delay the processing of your application if these fields are not marked.
There may also be supporting documentation required along with your Enrollment Application. We encourage you to submit documentation of your highest level of education so that we can accurately place you on an Alabama Pathways Professional Development Lattice Level; however, this documentation is not always required by Alabama Quality STARS. Refer to the Alabama Pathways PDR Enrollment and Documentation Requirements chart to determine what documentation is required at each STAR level.
Submit copies of your supporting documentation with your Enrollment Application. These documents will be kept on file with Alabama Pathways PDR and will not be returned. Please do not send original documents. If additional information and/or documentation is needed, you will be notified.
Identifying Information
First Name
*
Middle Name
*
Last Name
*
Maiden Name
Please write N/A if this does not apply.
Date of Birth
*
MM
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DD
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YYYY
Last FIVE (5) Digits of SS#
*
Contact Information
Home Mailing Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
County of Residence
*
Please select
Autauga
Baldwin
Barbour
Bibb
Blount
Bullock
Butler
Calhoun
Chambers
Cherokee
Chilton
Choctaw
Clarke
Clay
Cleburne
Cofffee
Colbert
Conecuh
Coosa
Covington
Crenshaw
Cullman
Dale
Dallas
DeKalb
Elmore
Escambia
Etowah
Fayette
Franklin
Geneva
Greene
Hale
Henry
Houston
Jackson
Jefferson
Lamar
Lauderdale
Lawrence
Lee
Limestone
Lowndes
Macon
Madison
Marengo
Marion
Marshall
Mobile
Monroe
Montgomery
Morgan
Perry
Pickens
Pike
Randolph
Russell
St. Clair
Shelby
Sumter
Talladega
Tallapoosa
Tuscaloosa
Walker
Wilcox
Washington
Personal Email Address
*
This is the e-mail address that Alabama Pathways PDR will use to correspond with you. If you receive an error regarding your email address when submitting this application, please contact us at 251-473-1060.
Primary Phone
*
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Provide the phone number that you want Alabama Pathways PDR to use should we need to contact you.
Cell Phone
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Demographic Information
Gender
*
Male
Female
Prefer Not To Answer
Ethnicity
*
Please select
Hispanic
Latino
Not Hispanic/Latino
Prefer Not To Answer
Race
*
Please select
Asian
Black
Hispanic
American Indian
Pacific Islander
White
Other
Prefer Not To Answer
Primary Language
*
Please select
Arabic
Armenian
Chinese
Creole
English
French
Greek
Hindi
Japanese
Korean
Lao
Persian
Polish
Portugese
Russian
Spanish
Swahili
Tagalog
Thai
Urdu
Vietnamese
Yiddish
Other
The language in which a person speaks most proficiently.
Secondary Language
Please select
Arabic
Armenian
Chinese
Creole
English
French
Greek
Hindi
Japanese
Korean
Lao
Persian
Polish
Portugese
Russian
Spanish
Swahili
Tagalog
Thai
Tribal
Urdu
Vietnamese
Yiddish
Other
Other language(s) in which a person speaks proficiently.
Learning Language
Please select
Arabic
Aremnian
Chinese
Creole
English
French
Greek
Hindi
Japanese
Korean
Lao
Persian
Polish
Portuguese
Spanish
Swahili
Tagalog
Tribal
Urdu
Vietnamese
Yiddish
Other
The language in which a person prefers to learn.
Formal Education Information
Highest Level of Education
*
Please select
No High School Diploma
High School Diploma/GED
1-Year Certificate
Associate's
Bachelor's
Education Specialist
Master's
Doctorate
Degree Name
Please select
Associate in Applied Science(AAS) Degree in Child Development
Associate in Applied Science (AAS) in Early Care and Education
Associate in Applied Science (AAS) in Early Childhood Education
Associate in Applied Technology(AAT) Degree in Child Development
Associate in Applied Technology(AAT) Degree in Early Care & Education
Associate in Applied Technology (AAT) in Early Childhood Education
Associate in Arts(AA) Degree in Child Development
Associate in Arts(AA) Degree in Early Childhood Education
Associate in Arts (AA) in Early Care and Education
Associate in Science(AS) Degree in Child Development
Associate in Science(AS) Degree in Early Childhood Education
Associate in Science (AS) in Early Care and Education
Bachelors Degree in Child Development
Bachelors Degree in Early Childhood Education
Bachelors Degree in Elementary Education
Education Specialist Degree in Child Development
Education Specialist Degree in Early Childhood Education
Education Specialist Degree in Elementary Education
Masters Degree in Child Development, Early Childhood Education, or Elementary Education
Masters Degree in Early Childhood Education
Masters Degree in Elementary Education
Doctorate of Philosophy (Ph.D) Degree in Child Development, Early Childhood Education, or Elementary Education
Doctorate of Education (Ph.D) Degree in Child Development, Early Childhood Education, or Elementary Education
Other
Degree Name if Not Listed Above
Field of Study
Child Development
Early Childhood Education
Elementary Education
Early Care & Education
Other
Field of Study if Not Listed Above
College/University
Date Degree Awarded
MM
/
DD
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YYYY
Do you have an Alabama Early Learning Guidelines Credential?
*
Please select
Yes
No
Do you have an Child Development Associate Credential?
*
Please select
Yes
No
CDA Expiration Date
MM
/
DD
/
YYYY
Have you completed training on the Program Administration Scale (PAS) assessment tool?
*
Please select
Yes
No
Center Directors - Supporting documentation of this training is required at all STAR levels.
Have you completed training on the ITERS assessment tool?
*
Please select
Yes
No
Center Directors - Supporting documentation of this training is required at all STAR levels.
Have you completed training on the ECERS assessment tool?
*
Please select
Yes
No
Center Directors - Supporting documentation of this training is required at all STAR levels.
Current Employment Information
Center Type
*
Please select
Licensed Center
Cannot be Licensed
Center Name
*
If your employer has multiple sites, please specify the site at which you work.
Center Physical Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Center's County
Work Phone
*
###
-
###
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####
Work Email
Current Position
*
Please select
Center Director
Center Owner/Operator
Center Teacher
Center Support Staff
Center Teacher Assistant
Other
Other Position
Please complete if you indicated your current position as "other" in the previous question.
Employment Start Date
*
MM
/
DD
/
YYYY
Are you Part-Time (less than 20 hours per week) or Full Time
*
Please select
Part-Time
Full Time
Ages of children you're working with 20 or more hours per week.
*
Please select
Infants - Birth to 12 months
Toddlers - 1 and 2 year olds
Preschoolers - 3 and 4 year olds
School-Agers - 5 to 12 year olds
N/A
Supporting Documentation for Pathways Application
Education Documentation
If you are submitting a college degree diploma, YOU MUST SUBMIT THE CORRESPONDING TRANSCRIPT IN ORDER FOR THAT DEGREE TO APPLY TOWARD YOUR LATTICE LEVEL.
Documentation of the highest level of education is required for teaching staff of centers applying for STAR levels Two, Three, Four and Five.
(Supported document types include pdf, jpg, png, or gif. The size limitation is 10MB per file. There are also several smartphone scanner apps that will convert photos to pdf format. We recommend Genius Scan, available on the Apple iTunes and Google Play Stores. If you don't have a scanner, a cell phone photo of the document will do!)
Upload High School Diploma/GED
(Supported document types include pdf, jpg, png, or gif.)
Upload Alabama Early Learning Guidelines Credential
(Supported document types include pdf, jpg, png, or gif.)
Upload CDA
(Supported document types include pdf, jpg, png, or gif.)
Upload Highest Degree Diploma
Please scan multiple Diplomas into ONE file. (Supported document types include pdf, jpg, png, or gif.)
Upload College Transcipt
Please scan all Transcripts into ONE file. (Supported document types include pdf, jpg, png, or gif.)
Professional Development Documentation (Training)
Training certificates verifying 4 clock hours of training above the Minimum Standards required annual training from an outside source are required at STAR levels Three, Four and Five.
(Supported document types include pdf, jpg, png. The size limitation is 10MB per file. There are also several smartphone scanner apps that will convert photos to pdf format. We recommend Genius Scan, available on the Apple iTunes and Google Play Stores. If you don't have a scanner, a cell phone photo of the document will do!)
Upload Training Transcripts or Certificates
Please scan Multiple Training Attendance Verification Certificates documents into ONE file in DATE ORDER. (supported file type include pdf, jpg or png,)
Additional Documentation
Please submit any PAS, ITERS and ECERS Certificates.
Documentation of this training is required for Center Directors at all STAR levels.
(Supported document types include pdf, jpg, or png. The size limitation is 10MB per file. There are also several smartphone scanner apps that will convert photos to pdf format. We recommend Genius Scan, available on the Apple iTunes and Google Play Stores. If you don't have a scanner, a cell phone photo of the document will do!)
Upload PAS Certificate
Upload ITERS-R Certificate
Upload ECERS-R Certificate
Signature and Date
I, the undersigned, have read and agree to all statements indicated in this application. I hereby agree that the information provided in this application form is complete, accurate, and will be entered in the Alabama Pathways Professional Development Registry. I understand that I am responsible for information included in this application and agree to update my information with Alabama Pathways Professional Development Registry when applicable.
I understand that the information in my profile will be used for the following purposes:
1. Your information will be shared with Alabama Quality STARS and used for center STAR level determination.
2. Your information will be used by Alabama Pathways Professional Development Registry for Lattice Level placement determination, recognizing individual’s education attainments (such as attainment of a Child Development Associate or Bachelor’s degree).
3. Your information will be used to compile, analyze, and publish group data reports.
Data compiled from the Alabama Pathways Professional Development Registry may be released to aid community and state planning to increase the quality and services of the early care and education community. Your name will not be released to advertisers. Information that could affect the safety and security of an individual (i.e. social security numbers, birth dates and personal addresses) will not be released to any individual or agency other than the Alabama Department of Human Resources and Alabama Quality STARS.
Name
*
First
Last
Date
*
MM
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DD
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YYYY
If you have questions or need assistance completing this form, please contact Alabama Pathways Professional Development Registry at:
E-mail Address- help@alabamapathways.org
Phone Number - 251-473-1060
Mailing Address - 3100 Cottage Hill Road; Building 4, Suite 400; Mobile, AL 36606